Laparoscopic-assisted vaginal hysterectomy versus minilaparotomy hysterectomy: a prospective, randomized, multicenter study.

Abstract

STUDY OBJECTIVE:

The aim of this study was to compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and minilaparotomy in a randomized clinical trial including patients undergoing total hysterectomy for benign gynecologic disease and having 1 or more of the generally considered contraindications to vaginal route.

DESIGN:

Prospective, randomized, multicenter trial (Canadian Task Force classification I).

SETTING:

Departments of Gynecology from 3 major university hospitals in Rome.

PATIENTS:

Eighty-one patients who were candidates for abdominal hysterectomy.

INTERVENTIONS:

Laparoscopic-assisted vaginal hysterectomy and minilaparotomy hysterectomy.

MEASUREMENTS AND MAIN RESULTS:

Forty patients were randomized to LAVH and 41 to minilaparotomy. Characteristics of patients and indications for surgery in the 2 arms were comparable. In the minilaparotomy group, complications were as follows: 1 case (2.4%) of delayed laparotomy with 2 units of red blood cell transfusion, 2 cases (4.8%) of wound infection, and 3 cases (7.3%) of fever of unknown origin. No minor or major complications were observed in the LAVH group. Postoperative visual analog scale pain scores at days 1 and 2 were significantly lower in the LAVH group (p <.05). The complication rate between the 2 groups was significantly lower for LAVH (p = .026).

CONCLUSION:

Because LAVH was associated with significantly lower early postoperative pain scores and complication rates, in general LAVH should be preferred to minilaparotomy hysterectomy when the vaginal approach cannot be used.

• Authors: Ludovico Muzii, Stefano Basile, Errico Zupi, Daniela Marconi, Marzio Angelo Zullo, Natalina Manci, Filippo Bellati, Roberto Angioli, Pierluigi Benedetti Panici
• Journal: Journal of minimally invasive gynecology (J Minim Invasive Gynecol) 2007 Sep-Oct Vol. 14 Issue 5 Pg. 610-5 ISSN: 1553-4650 [Print] United States
• PMID: 17848323 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial)

Topics

• Adult
• Contraindications
• Female
• Humans
• Hysterectomy, Vaginal (methods)
• Laparoscopy (methods)
• Laparotomy (adverse effects, methods)
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Treatment Outcome
• Uterine Diseases (surgery)